Terms Of Pharmacotherapy Research Articles

Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology: Clinical practice guideline for social anxiety disorder (2021).

The development of clinical practice guidelines for social anxiety disorder began in March 2018 when the Joint Clinical Practice Guideline Development Committee for Anxiety and Obsessive-Compulsive Disorders was formed by the Japanese Society of Anxiety and Related Disorders and Japanese Society of Neuropsychopharmacology to jointly develop guidelines for anxiety and obsessive-compulsive disorders. Based on the universal concept of evidence-based medicine, three clinical questions (CQs) about pharmacotherapy and psychotherapy were developed for clinical guidelines for social anxiety disorder, panic disorders, and obsessive-compulsive disorder in accordance with the Minds "Manual for Guidelines Development 2017 by the Japan Council for Quality Health Care: CQ1-"What is the recommended pharmacotherapy for social anxiety disorder in adults?"; CQ2-"What is the recommended psychotherapy (psychological intervention) for social anxiety disorder in adults?"; and CQ3-"What are the recommendations regarding monotherapy and combination therapy for social anxiety disorder in adults in terms of pharmacotherapy and psychotherapy (psychological interventions)?" Summarized recommendations for social anxiety disorder in adults are selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitor for CQ1, cognitive behavioral therapy for CQ2, and there are no recommendations regarding monotherapy and combination therapy for CQ3. These were answered by considering the balance between benefits and harms based on systematic reviews of each. The aim of this brief guideline for the standard-of-care (i.e., medical treatment) for social anxiety disorder in adults (18 years and older) was to help "shared decision making," in which medical professionals, including physicians, and patients share scientific evidence to decide on a course of treatment.

PREVALENCE OF POTENTIAL DRUG-DRUG INTERACTIONS AMONG PROLANIS TYPE 2 DIABETES PATIENT WITH HYPERTENTION IN PRIMARY HEALTH CARE: CROSS SECTIONAL STUDY

Potential drug–drug interactions (pDDIs) are important factors resulting in adverse drug reactions or therapeutic failure. Therefore, pDDIs need to be identified to prevent the related risk and improve drug safety. The objective of this study was to assess the prevalence of pDDIs among Prolanis type 2 diabetes patients with hypertension. Additionally, this study aims to categorize and rate the identified pDDIs according to mechanism, severity and level of significance. This cross-sectional study was conducted at Kramat Jati District primary health care. Patient medical records from January to June 2018, were analysed using Drug Interaction Facts and Stockley’s Drug Interaction for pDDIs with a total 138 patients identified. pDDIs were detected in 35 patients (25.4%), with a total 57 interactions. They were clinically relevant with major (42.1%) in severity and refer to level one of significance (42.1%). The interaction type was unknown (64.9%), pharmacodynamic (64.9%) and pharmacokinetic (12.2%) respectively. The most common interaction was amlodipine-simvastatin in 19 cases (33.3%). Prolanis type 2 diabetes patients with hypertension were at risk to pDDIs, particularly to major pDDIs. Screening of prescriptions and medical records for pDDIs also monitoring of pharmacotherapy in terms of response and associated adverse drug events will contribute to patient safety.

Cellular and neuronal mechanisms that underlie addiction - literature review

Abstract Introduction: Addictive substances act on a number of neurotransmitter systems, and the end result of this action is the activation of the reward system in the brain. The cellular and neuronal mechanisms that underlie addiction have long been searched for. One of such neurotransmitters is dopamine, a catecholamine synthesized in neurons located mainly in the midbrain. Material and method: The available literature was reviewed on the Pubmed platform and from other sources. The analysis included original studies, reviews. The aim of the study was to review the literature on the relationship between the DRD2 gene and the occurrence of substance addiction. Discussion: This work presents several currently discussed biological mechanisms, especially at the molecular and genetic level, involved in the process of addiction to various psychoactive substances. They discovered the brain structures that are most at risk, as well as other neurotransmitter systems and receptor proteins through which they can exert their pathological effects. It has also been established that exposure to psychoactive substances causes significant changes in expression in over 100 genes (including genes for dopaminergic, serotonergic and signaling pathways). The DRD2 receptor (present, among others, in the nucleus accumbens) plays an important role in the reward system, in the transmission of information. The weakening of this conductivity is a significant risk factor for the onset of clinical features that are associated with reward system deficiency syndrome. The expression of the D2 receptor gene may take up to 2 isoforms: short D2S and long D2L. Conclusions: Further research at the molecular level may result in the modification of psychotherapy and pharmacotherapy in terms of their personalization.

Computational analysis of arrhythmogenesis in KCNH2 T618I mutation-associated short QT syndrome and the pharmacological effects of quinidine and sotalol

Short QT syndrome (SQTS) is a rare but dangerous genetic disease. In this research, we conducted a comprehensive in silico investigation into the arrhythmogenesis in KCNH2 T618I-associated SQTS using a multi-scale human ventricle model. A Markov chain model of IKr was developed firstly to reproduce the experimental observations. It was then incorporated into cell, tissue, and organ models to explore how the mutation provided substrates for ventricular arrhythmias. Using this T618I Markov model, we explicitly revealed the subcellular level functional alterations by T618I mutation, particularly the changes of ion channel states that are difficult to demonstrate in wet experiments. The following tissue and organ models also successfully reproduced the changed dynamics of reentrant spiral waves and impaired rate adaptions in hearts of T618I mutation. In terms of pharmacotherapy, we replicated the different effects of a drug under various conditions using identical mathematical descriptions for drugs. This study not only simulated the actions of an effective drug (quinidine) at various physiological levels, but also elucidated why the IKr inhibitor sotalol failed in SQT1 patients through profoundly analyzing its mutation-dependent actions.

An Overview of the Methodologies and the Quality of Studies on Pharmacotherapy for the Treatment of Fibromyalgia.

It is often unclear whether systematic reviews and primary studies are de-signed to elucidate the efficacy or effectiveness of interventions. This may compromise the use of the information in clinical or policy decisions. This overview aimed to evaluate the methodological profiles of studies on fibromyalgia pharmacotherapy in terms of the quality and nature of the interventions (efficacy versus effective-ness). The protocol was registered in the International Prospective Register of Systematic Re-views database. Seven databases were searched for relevant publications. Systematic reviews inves-tigating the effectiveness or efficacy of fibromyalgia pharmacotherapy were included. Methodolog-ical quality was investigated using A MeaSurement Tool to Assess Systematic Reviews (AM-STAR), and efficacy andeffectiveness were evaluated using Rating of Included Trials on the Effica-cy-effectiveness Spectrum (RITES). In this overview, 4,107 studies were initially identified. 8 systematic reviews and 34 prima-ry studies remained after overlaps were removed. Of the eight systematic reviews, 4.76% (n=3) and 7.93% (n=5) were of moderate and high quality, respectively. An analysis of systematic reviews clearly showed the criteria "participants characteristics" and "trial setting" with the most frequent answers as scales 1 and 2 (strong emphasis on efficacy or rather strong emphasis on efficacy), re-spectively. RITES analysis revealed that the most frequent response was "strong emphasis on effi-cacy" in 68% (92/136) of primary studies. This analysis showed, in both systematic reviews and primary studies, a predominantly strong emphasis on efficacy, suggesting the need for methodological quality improvement in future studies, especially those designed to provide evidence related to effectiveness. The protocol for this overview has been registered in the International Prospective Register of Sys-tematic Reviews (PROSPERO; CRD42018095943).

Differences in treatment for Alzheimer's disease between urban and rural areas in China.

IntroductionIn China, the increasing number of people with Alzheimer's disease (AD) poses a great challenge to families and the country. Economic and cultural differences cause a urban-rural gap in medical resources. This multicenter survey aimed to investigate the real-world practice of disease treatment among people with AD.MethodsPeople with AD and their caregivers from 30 provincial regions in mainland China were enrolled from October 2020 to December 2020 to be surveyed for their treatment experience. Logistic regression was used to explore the factors that influence medication adherence in all areas, urban areas, and rural areas.ResultsIn this survey, 1,427 participants came from urban areas, and 539 participants came from rural areas. Patients in urban areas were older (mean age 74 vs. 70, p = 0.001), less frequently had mild AD (36.0 vs. 52.1%, p < 0.001), and more often were cared for at professional institutions (8.8 vs. 3.2%, p < 0.001). In terms of pharmacotherapy, 77.8% of people accepted taking lifelong medication, whereas 61.3% of patients insisted on taking medications. Although 72.0% of rural people believed in taking lifelong medication, only 30.0% adhered to drug use. The major factors that influenced medication adherence for all patients with AD were regional distribution (p < 0.001, OR = 6.18, 95% CI: 4.93–7.74) and family earnings (p = 0.003, OR = 1.22, 95% CI: 1.07–1.38). In rural areas, family earnings (p = 0.008, OR = 1.44, 95% CI: 1.10–1.89) and severity of AD (p = 0.033, OR = 1.31, 95% CI: 1.02–1.68) were the main factors. Family earnings (p = 0.038, OR = 1.16, 95% CI: 1.01–1.34) was the only factor among urban areas. Among all non-pharmaceutical activities except for cognitive intervention, the participation rates of rural patients were significantly higher than those of urban patients (p < 0.05).ConclusionAlthough national progress has been made in the public awareness of disease treatment, adequate diagnosis and medication adherence need to be prompted, especially in rural areas. Furthermore, lifelong treatment should be improved based on regional characteristics through the joint efforts of the government, health workers, and social volunteers.

In-depth bibliometric analysis and current scientific mapping research in the context of rheumatoid arthritis pharmacotherapy

Rheumatoid arthritis (RA) is a chronic multifactorial disorder of autoimmune etiology with a complex pathophysiological mechanism that is not yet fully elucidated. RA pharmacotherapy includes active molecules of chemical or biological nature that offer symptomatic relief and a slowing of progression, but still in a context of incurability. Therefore, the development of continuous research and multidisciplinary collaboration is essential. Although the management of RA is a topic of significant scientific relevance, existing bibliometric analyses are insufficient to assess this vast field. Consequently, the present study examines numerous manuscripts indexed in the Web of Science database using the VOSviewer software to provide through statistical interpretation of the data a comprehensive description of RA pharmacotherapy in terms of scientific impact, current state of research, number and frequency of citations, most prolific journals, authors, and countries, along with their relationships and other useful data for the literature search/publication process. Furthermore, the use of bubble maps of term occurrence has applicability in identifying current research trends in the field of RA pharmacotherapy as well as their evolution over the years. The leader in this field in terms of published papers is the United States, and the most prolific journal is Annals of the rheumatic diseases. The global management of RA, which is characterized by extensiveness and depth due to many variables, suggests the need for a conceptual framework based on pharmacotherapy coupled with comprehensive bibliometric studies, and the results may be useful for researchers in setting specific objectives that contribute to improving RA outcomes.

Analgesic effects of high-frequency and low-frequency TENS currents in patients with distal neuropathy.

Currently, diabetes mellitus (DM) is relevant problem, both for its prevalence and complications, including distal polyneuropathy (DPNP). At the same time, discussions continue on analgesic efficacy of transcutaneous electrical nerve stimulation (TENS) in DPNP. Aim of this study was to conduct a multi-faceted assessment of pain syndrome in these patients before and after TENS, taking into account levels of polyneuropathy, its severity and age of patients. The study was conducted in accordance with the research of the Federal State Budgetary Institution of the National Medical Research Center for Rehabilitation and Balneology of the Ministry of Health of the Russian Federation (CTR No. 121040100062-3) and with the permission of the Local Ethics Committee (IRB No. 2 dated 14.01.2021). The study included 75 patients with DM type II with DPNP, which are distributed into 3 groups of 25 people: Group 1a, patients received high–frequency TENS (HF); Group Ib, patients received low-frequency TENS (LF); as control, Group C received a standard method of pharmacological therapy without physiotherapy. Intensity of DPNP was evaluated before and after the course of treatment using a visual analog scale (VAS), the McGill Pain Questionnaire (MPQ), and a graphical linear analysis of pain on the neuropathic pain diagnostic questionnaire 4 (DN4) scale. TENS provides an analgesic effect that may exceed pharmacotherapy in terms of efficacy and safety. There was a 65.9% reduction in neuropathic pain according to VAS after a course of application, with the effects remaining up to 34% during the 6-month follow-up. HF TENS provided a higher significant analgesic effects than LF TENS, as it ensures the reduction of pain syndrome according to VAS by 25.8% (p <0.01), and total estimated characteristics - 35.5% (p <0.01), and touch - in at 58.1% (p = 0.001) and according to the scales of the MPQ (S) and DN4 - by 21% (p = 0.007). The observed differences in analgesic effects between HF TENS and LF TENS are based on analyses of pain in the immediate and long-term follow-up periods of type II DM patients with DPNP. These results, based on summation of the estimated parameters of the international pain scales support expectation of an expansion of the the use of analgesic TENS in aging patients suffering with DM of varying severity and extent of DPNP damage, a goal of great scientific and practical importance.

Binge eating disorder

To provide an updated overview of binge eating disorder (BED) that includes recommendations relevant for primary care practitioners.PubMed, Google Scholar, and PsycInfo were searched with no time restriction using the subject headings binge eating disorder, treatment, review, guidelines, psychotherapy, primary care, and pharmacotherapy. Levels of evidence for all treatment recommendations ranged from I to III.Binge eating disorder is associated with considerable patient distress and impairment, as well as medical and psychiatric comorbidities, and was added to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, in 2013. Primary care practitioners are well suited to screen, diagnose, and initiate treatment for BED. A stepped-care approach to treatment starts with guided self-help, adding or moving to pharmacotherapy or individual psychotherapy as needed. The psychotherapies with the most research support include cognitive behaviour therapy, interpersonal therapy, and dialectical behaviour therapy. In terms of pharmacotherapy, evidence supports the use of lisdexamfetamine, antidepressant medications, and anticonvulsant medications.This overview provides guidance on screening, diagnosis, and treatment approaches based on the currently available evidence, as well as expert opinions of a diverse group of experts to help guide clinicians where evidence is limited.

Guidelines for diagnosis and treatment of depression in older adults: A report from the Japanese Society of mood disorders.

The Committee for Treatment Guidelines of Mood Disorders, Japanese Society of Mood Disorders, published a Japanese guideline for the treatment of late-life depression in 2020. Based on that guideline, the present guideline was developed and revised to incorporate the suggestions of global experts and the latest published evidence. In the diagnosis of late-life depression, it is important to carefully differentiate it from bipolar disorders, depressive states caused by physical and organic brain disease, drug effects, and dementia, and to determine the comorbidity between late-life depression and dementia. It is necessary to fully understand the clinical characteristics and psychosocial background of late-life depression, evaluate the patient's condition, and provide basic interventions based on these factors. Problem-solving therapy, reminiscence therapy/life review therapy, and behavioral activation therapy, and other forms of psychotherapy can reduce depressive symptoms. In terms of pharmacotherapy, newer antidepressants or non-tricyclic antidepressants are recommended for late-life depression, and it is recommended that the efficacy of least the minimal effective dosage should first be determined. Switching antidepressants and aripiprazole augmentation can be used to treatment-resistant therapy. Electroconvulsive therapy and repetitive transcranial magnetic stimulation have demonstrated usefulness for late-life depression. Exercise therapy, high-intensity light therapy, and diet therapy also show some effectiveness and are useful for late-life depression. Continuation therapy should be maintained for at least 1year after remission.

What should patients do if they miss a dose of medication? A theoretical approach.

Medication adherence is a major problem for patients with chronic diseases that require long term pharmacotherapy. Many unanswered questions surround adherence, including how adherence rates translate into treatment efficacy and how missed doses of medication should be handled. To address these questions, we formulate and analyze a mathematical model of the drug concentration in a patient with imperfect adherence. We find exact formulas for drug concentration statistics, including the mean, the coefficient of variation, and the deviation from perfect adherence. We determine how adherence rates translate into drug concentrations, and how this depends on the drug half-life, the dosing interval, and how missed doses are handled. While clinical recommendations require extensive validation and should depend on drug and patient specifics, as a general principle our theory suggests that nonadherence is best mitigated by taking double doses following missed doses if the drug has a long half-life. This conclusion contradicts some existing recommendations that cite long drug half-lives as the reason to avoid a double dose after a missed dose. Furthermore, we show that a patient who takes double doses after missed doses can have at most only slightly more drug in their body than a perfectly adherent patient if the drug half-life is long. We also investigate other ways of handling missed doses, including taking an extra fractional dose following a missed dose. We discuss our results in the context of hypothyroid patients taking levothyroxine.

KEY POINTS IN FERTILITY PRESERVATION TREATMENT STRATEGIES DURING COVID-19 PANDEMIC. AN UPDATE ON PHARMACOLOGICAL THERAPIES

The fertility preservation (FP) field has developed in the two decades and offers women the possibility to have genetic children at some point in life. Fertility preservation is urgent by definition, performed for social reasons or medical indications, such as impending gonadotoxic therapy or radical gynaecological surgery. One year after the pandemic was declared, the COVID-19 infection imposed several restrictions and limited access to health care for the infertile couple. Ovarian stimulation is a pharmacological treatment used to induce the development of ovarian follicles;FP guidelines provide different options for ovarian stimulation. We performed a systematic search on fertility preservation (FP) procedures during the COVID-19 pandemic using the keywords: FP, ovarian stimulation, assisted reproduction techniques (ART), and COVID-19. In order to update the different treatment strategies in ovarian stimulation on fertility preservation studied in the last ten years, we searched for randomized clinical trials (RCTs) focused on therapeutic agents used in current protocols, gonadotropins, gonadotropin releasing hormone (GnRH), clomiphene citrate (CC), letrozole, androgens, metformin, tamoxifen, glucocorticoids, aspirin, coenzyme Q10, and sildenafil. Fertility may be influenced by SARS-CoV-2 infection - especially in men;until more evidence confirms the effects on fertility, patients with COVID-19 positive should delay FP procedures if possible. Access to fertility conservation services decreased during the analysed period due to the medical services restrictions and the reorientation of medical resources on patients with COVID-19, without major changes in the current therapeutic protocols. In terms of pharmacotherapy in ovarian stimulation (OS) procedures, letrozole is first line therapy, superior to CC for OS. Similar ovulation and pregnancy rate can be obtained in letrozole - induced ovulation compared to gonadotropin protocol. Adjuvant therapies may be used for OS but lack proven efficacy. Further studies on adjuvant therapies and complementary support are needed, to ensure optimal condition in assisted reproductive interventions for fertility preservation, especially in gonadotoxic therapies.

Prevalence of risk for obstructive sleep apnea in patients with bipolar disorder.

Aim:To evaluate the prevalence of risk for obstructive sleep apnea (OSA) among patients with bipolar disorder (BD).Methodology:Eighty-seven patients with BD and 50 matched controls were assessed by using the Berlin questionnaire.Results:One-fifth of the patients with BD was found to be at high risk for OSA, compared to the 6% prevalence in the control group. Patients in high risk for OSA were more often females, had significantly higher body mass index, high waist circumference, and comorbid physical illnesses. In terms of pharmacotherapy, there was association of use of antipsychotics with higher risk of OSA at the trend level (p=0.052).Conclusion:The prevalence of high risk for OSA is significantly higher among patients with BD and higher prevalence is related to obesity and comorbid physical illnesses.

Хроническая сердечная недостаточность в ассоциации с хронической обструктивной болезнью легких у лиц пожилого и старческого возраста: клинические параллели

In recent decades, the leading trend in the development of modern society is the aging of the population, as well as an increase in the proportion of elderly and senile people. Aging has a significant impact on the clinical characteristics, course and prognosis of diseases, changes the management tactics and treatment standards. As a rule, these patients are highly comorbid, which must be taken into account in terms of pharmacotherapy of the underlying and competing diseases. The purpose was to study the clinical characteristics of elderly and senile patients with chronic heart failure (CHF) in association with chronic obstructive pulmonary disease (COPD). Material and methods. The study included 104 patients with CHF, mainly of ischemic etiology, in combination with COPD, who were divided into 3 groups: 1 — younger than 60 years old, 2 — 60–79 years old, 3 — over 80 years old. To verify the clinical condition, the following studies were carried out: a 6-minute walk test, an assessment on the clinical condition scale, spirometry, echocardiography (Echo-KG), and an assessment of the quality of life according to the Minnesota questionnaire. Results. Patients older than 80 years old differed from those younger than 60 years old by high scores on assessment scale (p = 0,038), left ventricular ejection fraction (LVEF), (p = 0,007), and low heart rate (р = 0,021). The echocardiography parameters of patients over 80 years old were characterized by low values ​​of systolic pressure in the pulmonary artery (PAP) and end diastolic size (EDS) in comparison with those under 60 years of age (p = 0,004 and p = 0,038). When studying the respiratory function, it was noted that in patients with CHF in combination with COPD, the forced expiratory volume in the first second decreases with increasing age (FEV10 and functional vital capacity of the lungs (FVC), as well as Tiffno index. Conclusion. The study results demonstrated that the clinical profile of a patient with CHF in combination with COPD differs depending on age, which requires an integral approach to patient management tactics and stratification of the risk of adverse events.

Medication reconciliation upon admission in paediatric hospital setting: preliminary data.

Background The benefits of medication reconciliation are well established in adult patients, but not in paediatric patients, being a population not included in the guidelines for medication reconciliation published so far. However, it is known that a significant number of children suffer from chronic illnesses leadingto a complex pharmacological treatment. Moreover, there are a series of specific factors that cause a greater risk of medication errors in children. Aim The purpose of the present study was to determine whether patients from a paediatric hospital setting may benefit from medication reconciliation at hospital admission, in order to prevent and reduce prescribing errors on admission. Main outcome measures The primary outcome was the number of discrepancies between best possible medication history and prescribed treatment upon admission and, consequently, number of reconciliation errors. The secondary outcome was the main underlying diseasewith the highest number of reconciliation errors, and the main pharmacotherapeutic groups involved. Results The pharmacist reconciled the medication of187 patients with an meanage of 6.6 ± 5.1years. Sixty percentof patients had a base disease and 12.3% had polypharmacy, with an average of 6 drugs per patient. In a 42% of patients, at least one discrepancy was detected between their home treatment and the prescribed treatmentupon admission, with 15% of patients having at least one reconciliation error (68% omissions). Neurological diseases were the main underlying disease with at least one reconciliation error (50%). The main pharmacotherapeutic groups involved in reconciliation errors were psychoanaleptic and psycholeptic, anti-acids, antiepileptic, and obstructive airway pharmacotherapy; each accounting for a 17.1%, 14.7%, 11.8% and 11.8% of the total, respectively. Conclusion Within our sample of paediatricpatients, the rate of medication discrepancy and reconciliation errors at hospital admission was asrelevant in terms of pharmacotherapy as has been reported in adults. The most frequent type of errors was omission of some home treatments. The main underlying disease with at least one error was neurological. As a whole, the detection of reconciliation errors in paediatrics by provision of medication reconciliation could be effective in reducing medication errors.

Effects of Perennial Allergen Immunotherapy in Allergic Rhinitis in Patients with/without Asthma: A-Randomized Controlled Real-Life Study

Background: There have been very few studiesin real-life settingscomparing the treatment effects of allergen immunotherapy (AIT) and pharmacotherapy for perennial allergic rhinitis (AR). Objective: This study was performed to compare AIT and pharmacotherapy in terms of their effects on the symptom control and quality of life (QOL) of AR patients with/without asthma. Methods: A total of 250 patients diagnosed with AR with/without asthma were included and assigned to the immunotherapy (AIT plus pharmacological treatment) or control (pharmacological treatment only) group. Clinical and medication scores, QOL scores, and lung function (forced expiratory volume in one second as a percentage; FEV1%) were measured at baseline and 3 years after the start of treatment. Results: This study showed that there was clinical improvement in AR symptoms in the AIT group, whereas standard pharmacotherapy alone had no significant effect on nasal symptoms. The QOL and satisfaction scores, as evaluated with a visual analogue scale (VAS), were further improved compared to the pharmacotherapy group. There was a significant improvement in medication scores in both AIT groups. According to our results, while total asthma scores and asthma control test scores were significantly improved in the HDM AIT group, they did not change in the Parietaria pollen AIT group. In our study FEV1% was increased compared to the baseline value in the AIT group, but it was not statistically significant. On the other hand, FEV1% remained without any improvement in patients on standard pharmacotherapy. Conclusion: Perennial AIT was found to be superior to pharmacotherapy in decreasing symptoms as well as in improving QOL scores in AR patients with/without asthma. HDM AIT was more effective for asthma symptoms than Parietaria pollen AIT.

P3546EPIT-HF survey of chronic heart failure with preserved, mid-range and reduced ejection fraction. Focus on therapy

Abstract Background There is only a limited range of data on comparison of therapy for all three phenotypes of chronic heart failure (HF). Purpose In a prospective survey, to determine and compare pharmacological and non-pharmacological treatment for three phenotypes of chronic HF– HF with reduced, mid-range and preserved ejection fraction (HFrEF, HFmrEF and HFpEF). Methods The survey was performed by 115 cardiologists and 46 internists. Consecutive outpatients diagnosed with chronic HF aged at least 18 years were enrolled. There were no exclusion criteria. The HF phenotypes were defined according to LVEF: HFrEF – LVEF &lt;40%, HFmrEF – LVEF 40–49%, HFpEF – LVEF ≥50%. A total of 2 677 patients were enrolled. The subgroups of HFrEF, HFmrEF and HFpEF comprised of 1 169 (43.7%), 720 (26.9%) and 788 (29.4%) of patients, respectively. Results The pharmacotherapy and electroimpulse therapy was significantly different between the HF phenotypes. The most striking differences were found between HFrEF and HFpEF. Among these phenotypes, there were significant differences in the treatment prevalence across all drug classes, CRT-D, CRT-P and ICD. HFmrEF resembled HFrEF more than HFpEF in terms of pharmacotherapy. The prevalence of therapy for HFmrEF by any drug class, CRT-D, CRT-P and ICD, was always intermediate between HFrEF and HFpEF. Comparison of therapy HFrEF (1) HFmrEF (2) HFpEF (3) p (n=1169) (n=720) (n=788) Overall 1 vs 2 1 vs 3 2 vs 3 BB 91.9% 90.4% 83.4% &lt;0.001 0.275 &lt;0.001 &lt;0.001 ACEI 77.4% 71.1% 62.9% &lt;0.001 0.003 &lt;0.001 &lt;0.001 ARB 18.7% 23.3% 29.1% &lt;0.001 0.016 &lt;0.001 0.012 ACEI/ARB 92.8% 92.9% 87.7% &lt;0.001 1.0 &lt;0.001 &lt;0.001 MRA 80.1% 55.4% 28.9% &lt;0.001 &lt;0.001 &lt;0.001 &lt;0.001 Ivabradine 39.7% 34.7% 28.1% &lt;0.001 0.032 &lt;0.001 0.005 Furosemide 89.9% 75.0% 54.7% &lt;0.001 &lt;0.001 &lt;0.001 &lt;0.001 CRT-D 8.2% 0.8% 0.4% &lt;0.001 &lt;0.001 &lt;0.001 0.324 ICD 16.2% 2.2% 0.8% &lt;0.001 &lt;0.001 &lt;0.001 0.029 HTx 0.3% 0% 0.6% 0.104 0.304 0.498 0.063 Assist devices 0.3% 0% 0.1% 0.367 0.292 0.653 1.0 Conclusion We presented the real-world data on pharmacological and non-pharmacological treatment of all three phenotypes of HF. The therapy for HFrEF, HFmrEF and HFpEF differed significantly. Pharmacotherapy for HFmrEF has been more closely related to HFrEF treatment than to HFpEF treatment. Acknowledgement/Funding EPIT-HF survey was supported by the educational grant of Servier.

POTENTIAL DRUG-DRUG INTERACTIONS IN HEART FAILURE PATIENTS

Objective: The aim of the present study was to assess the prevalence, risk rating and the severity of hazardous pDDIs (potential drug-drug interactions) in the prescribed pharmacotherapy in the hospital discharged heart failure (HF) patients, primarily with co-administered drugs with narrow therapeutic index (statins, anticoagulants, antithrombotic drugs).&#x0D; Methods: The prescriptions of chronic heart failure patients for one year (January-December 2014) were analyzed for pDDIs through Lexi-interact® software. DDIs belonging to the categories D (Consider therapy modification) and X (Avoid combination) and/or severity of drug interaction-major, were selected for the study.&#x0D; Results: After reviewing the medical records of 985 patients, 239 patients were selected based on the criteria mentioned above. The average number of prescription drugs at hospital discharge was 7.27 medications (±1.84 SD) per patient. The total number of pDDIs was 1483 or approximately 6.2 (±3.89 SD) pDDIs per patient. With respect to the risk rating, in categories D and X were detected 76 (5.12 %) and 2 (0.13 %) pDDI, respectively. The major pDDIs were 108 (7.28 %).&#x0D; Conclusion: HF patients are at high risk of pDDIs. Screening of prescriptions for pDDIs and monitoring of pharmacotherapy in terms of response and associated adverse drug events will contribute to patient safety.

Potential drug-drug interactions in outpatient department of a tertiary care hospital in Pakistan: a cross-sectional study

BackgroundPotential drug–drug interactions (pDDIs) are one of the preventable drug related problems having the risk of serious adverse events or therapeutic failure. In developing countries like Pakistan, this issue remains poorly addressed. The objective of this study was to explore prevalence of pDDIs in the Outpatient Department (OPD) of a tertiary care hospital in Pakistan. The secondary aim was to describe the levels of reported pDDIs and develop a list of widespread clinically relevant interactions.MethodsPrescriptions of 2400 OPD patients were analyzed for pDDIs through Micromedex Drug-Reax®. Prevalence, severity- and documentation-levels and widespread clinically relevant interactions were reported.ResultsOf total 2400 prescriptions, pDDIs were present in 22.3%. Whereas, moderate- and major-pDDIs were found in 377 (15.7%) and 225 (9.4%), respectively. PDDIs were more prevalent in Medicine (9.2%) and Cardiology (2.6%) as compared with other OPD specialties. Total 942 pDDIs were identified, of which, the majority were either moderate- (61.9%) or major-pDDIs (32.1%). Some of the most common interactions were ibuprofen + levofloxacin (n = 50), ciprofloxacin + diclofenac (32), aspirin + atenolol (24), and diclofenac + levofloxacin (19). The potential adverse outcomes of widespread interactions were seizures, bleeding, QT-interval prolongation, arrhythmias, tendon rupture, hypoglycemia/hyperglycemia, serotonin syndrome, drug toxicity, and decreased therapeutic response.ConclusionsOPD patients were at risk to pDDIs, particularly to major- and moderate-pDDIs. Screening of prescriptions for pDDIs and monitoring of pharmacotherapy in terms of response and associated adverse drug events will contribute to patient safety.

Economic evaluation of paliperidone palmitate once monthly for treating chronic schizophrenia patients in the United Arab Emirates

Objective: Schizophrenia is one of the most debilitating diseases in the United Arab Emirates. Oral antipsychotics (OA) are commonly used in terms of pharmacotherapy; however, these treatments can be rendered ineffective by poor patient adherence. Paliperidone palmitate once monthly (PP1M) is a long acting antipsychotic which can offer an adherence advantage when compared to oral treatments. The study objective is to estimate the cost effectiveness of PP1M in the UAE setting.Research design and methods: A 1-year validated decision-tree model was adapted to the UAE setting using published literature and expert opinion. Patients on PP1M were compared with or without oral supplementation to patients on any oral antipsychotic. Patient outcomes studied were incremental cost per quality adjusted life years gained, incremental cost per hospitalizations, relapses, and emergency room visits averted.Results: After 1 year, patients on PP1M monotherapy when compared to oral antipsychotics had better outcomes (0.840 vs 0.811 QALYs; 31 relapse days averted as well as 9 and 24 percentage points of ER and hospitalizations averted, respectively), and better healthcare savings (AED 1405). PP1M economically dominated oral antipsychotics. The results were stable across a broad range of deterministic and probabilistic sensitivity analyses. PP1M plus oral antipsychotics could not be evaluated due to the absence of clinical data that would provide insight into the clinical value of combination therapy.Conclusion: PP1M is estimated to save the UAE healthcare system money, while at the same time improving patient outcomes.